1487749768 NPI number — MARTHA HIGGINBOTHAM ALDRIDGE M.D.

Table of content: MARTHA HIGGINBOTHAM ALDRIDGE M.D. (NPI 1487749768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487749768 NPI number — MARTHA HIGGINBOTHAM ALDRIDGE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALDRIDGE
Provider First Name:
MARTHA
Provider Middle Name:
HIGGINBOTHAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487749768
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1061 HARMON AVE., DEPT. OF OB/GYN
Provider Second Line Business Mailing Address:
1061 HARMON AVE., DEPT OF OB/GYN
Provider Business Mailing Address City Name:
FORT STEWART
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31314-0610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-435-6862
Provider Business Mailing Address Fax Number:
912-435-6017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 FRIENDSHIP STREET
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-848-5556
Provider Business Practice Location Address Fax Number:
401-845-4379
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MD16490 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 65781 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 17213 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 510 04824 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 511-20169 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051559122 . This is a "MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: MD16490 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 009941501 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515 39477 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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